Giving up a Living, to Save Lives

Beatrice Miguoke knows what it means to take up a calling to save lives. In the 1980s she became her village’s traditional birth attendant. And for more than ten years, she helped hundreds of women safely birth their babies in her house with her bare hands. While she never set a price on the deliveries – insisting that such a special act was priceless – she made a decent income from the rewards that happy families offered her as they departed with their babies.

But when HIV swept through Kenya in the 90s killing many in her own village, the Kenyan government ordered a stop to home deliveries. Traditional birth attendants, like Beatrice, were required to work themselves out of their traditional midwifery jobs by referring all pregnant women to health facilities. That new role would be unpaid, done on volunteer basis.

That was hard to take for some traditional birth attendants, so they went underground and continued their work against the government directive. Not Beatrice. While she didn’t have any other reliable income, the message about the dangers of HIV infection was so loud and clear that she decided to give up her career as a midwife. HIV had changed everything, she says.

Today, as a community health volunteer in Siaya County in Kenya, Beatrice and her colleagues are the first line of defense against many diseases in her community. At 62, she remains driven by the vision of a community where all pregnant mothers and all babies get prevention against the virus. She attributes her devotion and passion to lessons she has learnt from some devastating tragedies in life. She lost two of her six children to HIV. One of those left behind a daughter living with HIV, whom Beatrice now supports. She is also supporting a son who is also living with HIV.

Those experiences have made her give herself fully not only to the cause of fighting HIV but also to responding to other diseases, especially those that affect pregnant women and children. One such other disease is malaria, which is particularly lethal to pregnant mothers and children under five.

On a recent afternoon, Beatrice and a colleague walked down a dirt path in her village to visit Belinda Otieno who had called to say her five-year-old son was sick. The mother suspected malaria.

Belinda herself was still recovering from a challenging pregnancy and delivery of her two-month-old son, Michael. The pregnancy had been complicated by a serious bout of malaria. But the community health volunteers had supported her well through it all. Today they were back for other urgent business – taking care of Denzel, Belinda’s older son, who was running a high fever.

In areas around Lake Victoria in Kenya – where Belinda lives – malaria presents significant risk to mothers and children under five. Malaria in pregnancy also increases cases of stillbirth. To stay free of the challenges wrought by the disease, the health volunteers engage the community with health education on how to use to use mosquito nets, how to eliminate mosquito breeding grounds, and how to seek timely treatment when the disease happens.

Beatrice and her group are the glue that holds the community together in efforts to control diseases. The volunteers working with Amref Health Africa in Kenya and supported by the Global Fund are giving women and their children a fighting chance against a disease that most people in this region of Kenya regard as their number one challenge in life.

When they tested Denzel using a rapid diagnostic test kit, they confirmed he had malaria and promptly started him on malaria treatment. The test kits and the malaria drugs that they carry in their bags are lifesaving tools of the trade for the health volunteers.

Up the hill from Belinda’s home, Beatrice and her colleague detoured to pass by Evaline Odiwuor’s home, where they had been called to check on her two boys, Zakaria and Brorence who were also unwell. Just a few weeks ago they had been here, when Zakaria had again tested positive for malaria and had been put on treatment. Today, again, he tested positive and was put on medication. Brorence’s test returned a negative result.

Malaria testing and treatment in the hands of communities

Zakaria’s constant struggle with malaria underlines the challenge with fighting the disease. Beatrice’s message of tucking in the net well may be well appreciated, but more complex issues such as poverty get in the way. Belinda’s and Evaline’s homes are mud-walled with dark corners, which are the perfect sites for mosquitos to lurk. And while the boys in both homes may have mosquito nets, there is no mattress to tuck them under. They boys spread a mat on the floor and make efforts to tuck the silky net underneath. Often, that is not enough to block openings where sneaky mosquitos can squeeze through to bite the boys.

The burden of having to take care of sick children – and of themselves while fighting malaria – exerts a toll on the women here, often keeping them out of the workforce and creating a vicious cycle of poverty. Poverty creates malaria; malaria creates more poverty.

The work of the community health volunteers, while impressive, cannot be done in isolation, as there are numerous dynamics that make the families poor. The Global Fund partnership continues to explore ways of linking up with investments made to tackle the three diseases while at the same time seeking ways to fight the underlying causes of poverty.

The community health workers play an integral role: they advise families to clear their bushes, to drain stagnant water. They give them the nets and show them how to tuck them in to fend off mosquitos. They hold community outreach sessions where they emphasize the need for prevention activities against the disease. But when all those efforts fail and the mosquitos leave their hideouts, squeeze in through the nets and bite, the health volunteers come around with their test kits and medicine. They test and treat the people. For the pregnant women, they refer them to the health facilities for more comprehensive care. That keeps the families going. Until the next bout.

The swift help from the community health workers is often lifesaving. Malaria is lethal if not treated quickly. “When I call her, she comes – even if in the middle of the night,” says Evaline about Beatrice with a broad smile. “My boys would be dead were it not for her.”